先天性心脏病术后体外膜肺氧合支持17例病例系列报告

Extracorporeal membrane oxygenation support in 17 infants after congenital cardiac surgery:A case series report

目的总结体外膜肺氧合(ECMO)在婴儿先天性心脏病(先心病)术后应用的临床经验,评价其效果。方法纳入2018年6月1日至2019年12月31日在河南省人民医院行先心病手术且术后应用ECMO支持的患儿,从病历系统中截取患儿的一般信息和临床资料。结果17例先心病患儿术后应用ECMO支持,男8例、女9例,年龄13日龄至11月龄,体重2.8~6.9(4.7±1.2)kg;4例因术后出现低心排、心脏骤停行ECMO,13例因术后心功能差、不能停体外循环转ECMO。ECMO支持时间13 h至26 d。成功撤机11例(64.7%),痊愈出院8例(47.1%),死亡或放弃治疗9例。2次开胸止血7例(41.2%);更换膜肺氧合器3例(17.6%);肾功能不全行腹膜透析6例(35.3%);肺部感染5例(23.5%),其中1例全身重度感染,血培养鲍曼不动杆菌阳性(5.9%);多器官功能障碍和消化道出血各3例(17.6%)。4例术后在监护室行急诊ECMO者均死亡。结论ECMO是先心病术后心功能衰竭的重要生命支持手段,应把握好适应证和上机时机,积极防治相关并发症。

Objective:To summarize the clinical experience of extracorporeal membrane oxygenation(ECMO)in infants after cardiac surgery and evaluate its effect.Methods:The infants who had undergone ECMO support after surgery for congenital heart disease in Henan Provincial People’s Hospital from June 1st,2018 to December 31st,2019 were included.The general information and clinical data of them were retrospectively analyzed.Results:There were 17 cases including 8 males and 9 females who underwent ECMO after congenital cardiac surgery.Their age and weight ranged respectively from 13 days to 11 months and from 2.8 to 6.9 kg(average,4.7±1.2 kg).Four cases underwent ECMO due to postoperative low cardiac output and cardiac arrest,and other 13 cases were transferred to ECMO due to poor cardiac function and failure to stop cardiopulmonary bypass.ECMO support time was 13 hours to 26 days.As a result,11 infants(64.7%)were successfully weaned from ECMO and 8 infants(47.1%)were discharged from hospital.Nine cases died or gave up the treatment.Seven cases(41.2%)underwent secondary thoracotomy for hemostasis.Three infants(17.6%)due to renal insufficiency underwent membrane replacement.Six infants(35.3%)underwent perytoneal dialysis.Pulmonary infection occurred in 5 cases(23.5%),including 1 case(5.9%)with severe systemic infection and positive blood culture(Acinetobacter baumannii).Three cases(17.6%)had multiple organ dysfunction and 3 cases(17.6%)had gastrointestinal hemorrhage.All the 4 cases who underwent ECMO in ICU died.Conclusion:ECMO is an important life support method for infants with heart failure after heart surgery.The key to successful treatment is to grasp the indications,shorten the operation time and prevent the related complications.